Background: There is limited research on how web-based, point-of-care, evidence-based medicine (EBM) tools, such as evidence summaries, are being implemented and used in developing countries. Objectives: To investigate accessibility, use, and impact of an online EBM knowledge dissemination portal in orthopaedic surgery. To explore whether receiving daily targeted evidence summaries results in more frequent use of an EBM tool compared with receiving general weekly reports. To identify and explain the barriers and benefits of a point-of-care resource in the Indian context. Methods: Forty-four orthopaedic surgeons in Pune, India, were provided free access to OrthoEvidence (OE), a for-profit, online EBM knowledge dissemination portal. Participants were subsequently randomized to an Intervention group receiving daily targeted evidence summaries or a Control group receiving general weekly summaries. This study employed an explanatory sequential mixed methods design that incorporated two questionnaires, OE usage data, and semi-structured interviews to gain insight into the surgeons’ usage, perceptions and impact of OE. Results: There were no observable differences in OE usage between the Intervention and Control groups. OE was deemed to be comprehensive, practical, useful, and applicable to clinical practice by the majority of surgeons. The exit survey data revealed no differences between groups’ perceptions of the OE tool. Semi-structured interviews revealed barriers to keeping up with evidence that included limited access to relevant medical literature (limited internet connection, lack of time, minimal access to medical journals) and limited incentive to keep up with it (limited decision-making powers for residents, textbook-based residency curriculum, lack of research methods knowledge, limited context-specific research). Changing trauma practices at the hospital were noted following the intervention. Recommendations: The practice of EBM and the use of point-of-care tools in India can be promoted by investing in adequate electronic infrastructure (improvements to internet access) and by integrating EBM into training programs and surgical cultures. / Thesis / Master of Science (MSc)

Educational collaborative networks (ECNs), as instruments for achieving educational goals through the integration of non-governmental organisations (NGOs), have become frequent elements of public education worldwide. Despite their contribution of additional resources to the education enterprise, the roles of philanthropic foundations in ECNs are particularly controversial. Research suggests that leaders of ECNs such as policy makers, administrators, and school principals design and coordinate governance structures to guide participants’ behaviour. However, the importance of governance design and coordination in ECNs for governing philanthropic roles is yet to be systematically analysed. This article centres on the relationship between the design and coordination of governance boards and role-related participation of philanthropic foundations. A mixed methods design is implemented based on secondary analysis of a German large-scale standardised survey and an in-depth case study conducted in a south German municipality. Results confirm that leaders of ECNs impact philanthropic engagement via the design and coordination of governance boards. Participation in ECNs can take on diverse roles of representing particular interests, pursuing innovation, or providing services and are explained by underlying governance-related mechanisms. Identified associations within governance boards and role-related participation of philanthropic foundations in ECNs offer valuable insights for leadership in education.

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Background: People from ethnic minority immigrant groups living in host countries are known to have higher risk factors for cardiovascular diseases. The role of acculturation, or assimilation into a different and dominant culture, is often studied from social and medical views when focusing on individuals diagnosed with cardiovascular diseases and their recovery after cardiac events. However, the effects of the complex roles of acculturation and religious coping on these individuals are rarely considered in the research. There is limited knowledge regarding the complex roles of acculturation and religious coping in adopting healthy lifestyle behaviours and managing stress among individuals with cardiovascular diseases from Arab communities in the Ottawa region. This research project’s general purpose was to explore and understand the complex roles of acculturation and religious coping through the experiences of individuals diagnosed with CVD from Arab communities in the Ottawa region. Objectives: The specific objectives were to 1) identify and understand the challenges among Arab immigrants related to acculturation and religiosity in adopting healthy lifestyle behaviours and managing stress; 2) measure and describe the levels of religious beliefs as well as religious coping strategies, acculturation, perceived stress, and healthy lifestyle behaviours among Arab individuals living in the region of Ottawa, Ontario, Canada who have been diagnosed with cardiac events or who are at high risk for cardiovascular diseases; and 3) explore the role of acculturation and religious coping in shaping male Arab individuals’ lived experiences after a cardiac event and to explore their ways of understanding lifestyle behaviours and cardiac rehabilitation during recovery. Methods: A mixed-method approach was adopted in this research, which included three separate studies: Study 1 was a qualitative study (views of key informants with first-hand knowledge) in which three face-to-face focus groups were conducted with 17 Arab health promoters; Study 2 was a cross-sectional survey study was conducted with 63 individuals from local Arab communities who had been diagnosed with cardiac events or who were at high risk for cardiovascular diseases; and Study 3 consisted of a phenomenographic qualitative study, semi-structured in-depth interviews with male Arab individuals (N=10), selected from Study 2, who identified themselves as having had cardiac events while living in Canada. Results: From the perspective of Arab health promoters, there was an overlapping between various aspects of acculturation and religious beliefs that may have impacted the healthy lifestyle of Arab immigrants. These challenges were coded in four themes: “Culture first!”: dominant influence of home country culture; “Religiosity alone does not make you healthy!”: limited religious influence; “It is not easy!”: difficulties adapting to the Canadian lifestyle; and “We are not young!”: generational differences in adopting a healthy lifestyle. Findings from the survey study indicated that most participants were oriented more toward their Arabic culture than Canadian culture. Participants tended to be religious, and their nutritional behaviours were healthier than physical activity behaviours. However, age, gender, and interestingly, length of time living in Canada did not affect the participants’ results in any of the questionnaires. Based on lived experiences of 10 participants in the interview study, five core themes were identified: “Stressful events or cardiac events!”: acculturative stress effects; “It was a dreamlike event!”: dismissing perceptions of cardiac events; “recognizing risk factors is not enough to avoid them”: perceived threat; religious coping outcomes: satisfaction and fatalism; Cardiac Rehabilitation programs: who refers and who participates. Conclusion: This dissertation showed that acculturation level plays an essential role in Arab immigrants’ beliefs and behaviours regarding their health status and their experiences in preventing cardiovascular diseases risk factors or in recovery after cardiac events. Religious coping seems to be a way for less acculturated Arab immigrants to manage stress and mental burdens and find internal peace and satisfaction. From the perspective of Arab health promoters, some religious or cultural beliefs may be barriers to engaging in physical activity, especially for women and older people, and these barriers may be exacerbated by acculturative stress. Religiosity may also play an essential indirect role in managing stress through socialization, family support, and the adoption of coping strategies. Arab individuals living in the region of Ottawa, Ontario, Canada, who have been diagnosed with cardiac events or who are at high risk for cardiovascular diseases may have been more religious and less acculturated in Canadian society. Their lifestyle health behaviours related to physical activity and nutrition may have been influenced by their health status, religious beliefs, and the practices or traditions of their culture of origin. Stress and mental burdens while living in Canada reflected negatively on Arab male individuals’ experiences with cardiac events. Stress was perceived as a potential cause of cardiac events and a factor leading to low self-efficacy in changing lifestyle behaviours. There is a need to promote healthy lifestyle messages and raise awareness about cardiovascular diseases risk factors among Arab communities. Future research is needed to design culturally adapted cardiac rehabilitation programs for Arab individuals and to evaluate the effectiveness of interventions with both physical and mental health components.

PURPOSE: The purpose of this study was to examine the effect of a modified judo training program on psychosocial health in both typically developing (TD) and children with Autism Spectrum Disorder (ASD) using a mixed-methods approach. METHODS: The sample consisted of 5 children with ASD and 5 TD children (age=8-11yrs) who participated in 10 sessions of a modified judo program during their typical physical education time for school. Psychosocial factors (enjoyment, perceived competence, benefits of PA) were assessed at baseline and post intervention, with completion of all measures dependent upon the level of comfort expressed by the participant. At the end of the program, children took part in focus group discussions centered around their experience with the program, while key school staff participated in semi-structured interviews based on their observations of the program. All focus group discussions and interviews were audio-recorded and transcribed verbatim. RESULTS: Quantitative results for pre and post psychosocial measures showed no significant differences existed between PA self-efficacy (p=.99), PA enjoyment (p=.6), and barriers to PA (p=.27). Qualitative results revealed that the majority of the participants found the program to be enjoyable, with partner centered activities being particularly fun. Suggestions for improvement included increasing the duration and frequency of the judo classes. All children reported a desire to continue participating in the judo classes. Findings from staff interviews indicated that school staff observed improvements in psychosocial health and behavior both immediately following a judo class, and throughout the intervention period. Increased self-confidence was mentioned by all participating school staff members. CONCLUSION: Despite the lack of significant quantitative findings, psychosocial benefits were observed in both TD children and children with ASD, with all participants reporting their desire to continue with the program. Future studies should examine the psychosocial benefits in a judo-training program in larger sample of children over longer durations.

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